How Do Mandated Disability Supports (Vocational Rehabilitation) Affect Power Roles Between Clients and Service Providers?
Community Rehabilitation and Disability Studies, University of Calgary, Calgary, Alberta, Canada
Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Email: Megan Darvill
Power roles and power dynamics are an unintentional struggle between clients within mandated government programs and their assigned health care professionals. In vocational rehabilitation services, there is the potential for power roles to intrude on the care and success of support for individuals with disabilities. In the paper, we reflect on our shared experience as practicum students within vocational rehabilitation services, the power roles, and the power dynamics that we have witnessed between clients with disabilities and vocational specialists. We explore the role of the Workers Compensation Board (WCB) in conjunction with vocational rehabilitation specialists to examine the power dynamics that shape interactions with the client. Through our shared experiences, we examine how misunderstandings within mandated supports can affect the power dynamics between the service provider and the client and the overall outcome for the client. The outcome of our shared experience demonstrates that further research on the roles of power dynamics within government-mandated supports for persons with a disability is needed within disability studies.
Disability, Vocational Rehabilitation, Vocational Support Services, Workers Compensation Board (WCB), Employment Programs, Government-Mandated Programs
Government-mandated programs in which a person is directly placed following an injury or illness can have beneficial or adverse consequences for individuals with a disability. These mandated programs may be necessary for an individual to obtain specific funding or benefits after an injury or illness. From our practicum experience we researched what vocational rehabilitation entailed, including an examination of re-employment government programs through vocational rehabilitation services that shift the balance of power between provider and client. In vocational rehabilitation services, the primary goal is to return individuals with disabilities to paid employment (Wang & Lin, 2017, p. 244). When individuals have sustained an injury, accident, or disease in their workplace, they could be entitled to compensation from the Workers' Compensation Board (WCB). The WCB in Alberta provides compensation which includes wage-replacement benefits and medical aid to individuals who have suffered work-related injuries during employment (Calgary Legal Guidance, 2021). If the individual is having difficulties finding or returning to work, WCB may refer the individual to support services such as vocational rehabilitation services. However, WCB may not be well known because some employers focus on in-house workplace accommodations when an individual gets injured. This can lead to an individual experiencing a temporary or permanent disability. The client and vocational specialist's power roles and power dynamics may become more evident when the WCB or vocational services are not fully understood or supported by the client. The individual may not fully understand the purpose of vocational rehabilitation services in their treatment or recovery.
Vocational services often use a person-centered approach to address individual needs such as health, skills, and abilities. Therefore, the services that are offered are to meet the individual needs. Wagner et al. (2011) state that to facilitate a successful return to work process, the vocational service provider should be “supportive, engage in active listening, consideration, respecting the individual’s opinions and concerns, social and emotional support, personal involvement, accessibility, and being an advocate” (p. 46). By adhering to these practices, the vocational specialist can better interpret the issues of equal power distribution, which may enable the client to identify specific needs and participate actively in their re-employment journey.
Talking with clients may disclose feelings of anxiousness, uncertainty, and stress regarding the re-employment services when talking with the clients. Many clients are not informed about the types of services they are being placed into by their WCB case manager. Thus, the client gets a brief explanation of the services they are going to be participating in for their re-employment plan only when re-employment services staff make contact.
One role as practicum students was to directly contact the clients and book them in for their re-employment services that are referred from WCB. Through these direct conversations, we were instructed to provide a brief description of the services. We found that clients still had feelings of concern because they worried about the types of job opportunities that would be presented to them. They worry that their only job opportunities are going to be low-wage employment, such as a Walmart greeter. Clients lack a clear understanding of the services being provided because various re-employment services sound similar and personal fit may be misinterpreted. These interactions can be confusing when a client experiences an imbalance of power that could affect their future employment. One wants to be empathic and understand their feelings towards the services. On the other hand, if a client chooses not to participate, the vocational services teams are responsible for informing the WCB case manager, which in turn, leads the case managers to identify the risk to continued compensation funding. The WCB manager has the power to threaten continued funding creating greater fear and anxiety between the individual and specialist.
While vocational services can help clients obtain employment by highlighting the individuals’ capabilities and valuable skills into new careers, we noted that clients experience challenges with transitioning into new careers. One of the challenges that was reported related to recommended job opportunities that do not satisfy their expectations. Workplace injury/illness may not only restrict the client from returning to their previous role but also alienate them from that career choice completely.
During our practicum, we noted a particular interaction between a client and a vocational rehabilitation specialist. The client became increasingly upset with the specialist when she suggested the client should consider an employment opportunity as a grocery bagger deemed to be within the client’s skillset. The client, who had worked as a carpenter for over 25 years, was personally insulted by the vocational team’s recommendation to apply for employment that he felt was deeply beneath his skill set and expertise. He continued to argue that despite his disability, there must be something more comparable to his previous career than a grocery store bagger. The vocational team responded, ‘it’s the only thing out there that is suitable for you’ and did not provide him with any other options. A few weeks later, the client relinquished funding and withdrew from the program, remaining unemployed. In this specific example, the vocational team failed to advocate for the client and acknowledge the challenges surrounding his unique disability. The vocational specialist’s goals were not achieved and the person with the disability was further disempowered.
Another example of a power imbalance we experienced was when a client was open to ‘any type of employment out’ there regardless of the job position but was restricted by mandated guidelines. One client we spoke with was willing to do anything mandated by the program so long as they were able to find appropriate employment. However, when the specialist compared the specific job requirements with the client’s abilities and employment history, barriers to employment placement were encountered due to mandated employment guidelines. The role of vocational specialists requires clients to spend significant amounts of time trying to find anything and everything that could lead to potential employment; however, the services can be unsuccessful at finding anything that is suitable or desirable to the client. Unsuitable employment opportunities could be due to the client’s physical or cognitive restrictions, their lack of a certain employment experience or skills, and/or their lack of educational background.
While the vocational specialists want to find ideal employment for their clients, they act as the ‘middle person’ where they can only advocate so much for the client’s employment goals based on their immediate abilities, skills, and knowledge. When vocational specialist reports are obligated to inform WCB, outlining a client’s refusal or inability to seek employment outside their desired career or perceived abilities, the WCB case managers are often opt to discharge the client from mandated programs. Therefore, the such interactions amongst the vocational specialist, the client and the WBC program demonstrate the limited scope of the vocational services to continue to advocate for the client. We heard accounts that suggest sometimes WCB case managers fail to acknowledge or promote other ways a client may be assisted, such as gaining more experience or accessing proper education. Rather, the client is discharged from the mandated program as a means of keeping caseloads moving.
Based on our practical experiences within a government-mandated vocational rehabilitation service for clients with disabilities seeking employment, we noted a struggle of power between the client and service provider. Through our experiences, we believe that power dynamics and power roles are primarily influenced by the service provider team interactions and the understanding of the program or funding guidelines of services such as WCB will correspond to the acceptance and ultimate successful recovery or re-integration of the client. Additionally, in our practical experience, we found that when clients are placed in a mandated program and have been enrolled against their wishes, they may harbor resentment towards the program before they even begin. This can impact the program’s overall effectiveness, as an individual who does not want to be there, may minimally participate in the program or withdraw completely. Once again, this can lead to power struggles between the specialist and the client. When the perceived power is seen to be in the hands of the specialist making the decisions, the client can become disengaged and may seek an exit from the program as quickly as possible by meeting predetermined basic requirements or obtaining alternative funding.
Through our practical experience, we observed the interactions that influence the dynamics that result in power imbalance. Such interactions appear to be primarily influenced by forced placement within government programs, the client’s overall understanding of support services (such as vocational specialists’ role in non-mandated government programs), and by WCB program. These constraints and potential misunderstandings ultimately place the client in a more significant disadvantage position, negatively influencing their overall recovery. We believe that further research is needed in disability studies to better understand the practical implications of power that leads to dysfunctional interactions between service providers such as vocational rehabilitation services and a client with a disability. By further researching and recognizing pre-existing power dynamics between service providers and clients with disabilities, outcomes of client-mandated services may find additional strategies to be more efficient and successful at placing clients in long-term employment. Improving client and vocational rehabilitation services interactions will potentially promote the successful integration of the client back into the workforce.
Calgary Legal Guidance. (2021). Worker’s Compensation Board. Alberta Law Foundation. Retrieved from https://clg.ab.ca/programs-services/dial-a-law/workers-compensation-board/
Wagner, S. L., Wessel, J. M. & Harder, H. G. (2011). Workers' perspectives on vocational rehabilitation services. Rehabilitation Counseling Bulletin, 55(1), 46–61. https://doi.org/10.1177/0034355211418250
Wang, Y. & Lin, Y. (2017). Vocational rehabilitation case manager factors associated with
vocational rehabilitation service program outcomes for people with disabilities in Taiwan - an exploratory study. Disability and Rehabilitation, 39(3), 244–250. https://doi.org/10.3109/09638288.2016.1140838
International Journal of Disability, Community &
Volume 19, Student Perspectives